Community-based Environmental Health Assessment, New Mexico

PACE EHin New Mexico

Several projects converged to bring the practice and benefits of PACE EH to New Mexico. In the southern part of the state, funding from the New Mexico Department of Health's Border Health Office was made available to the Southern Area Health Education Center (SoAHEC) to conduct a pre-assessment of individual communities' readiness to participate in PACE EH. The pre-assessment was based on the following principles:

Community-based environmental health assessments support the basic functions of public health;

Stronger leadership capabilities make local health officials more effective;

Community cooperation and support is important in a health assessment process; and

Environmental justice is important for the practice of public health.

Its purpose was to develop criteria, compile existing data, and collect primary data to determine which communities in the border region would be appropriate to conduct the Community-Driven Environmental Health Assessments (CDEHA).The criteria used were:

Knowledge and attitudes regarding environmental health issues;

Extent of current cooperation and support from the community;

Interest and ability;

Key community resources, skills, and capacities; and

Major environmental health issues affecting target communities.

Ultimately, Doña Ana and Luna Counties were chosen to be sites for the pilot projects of PACE EH in New Mexico.The SoAHEC used a comprehensive approach to environmental health when managing activities of community outreach in environmental health awareness, assessment, and program action. A plan called the Community-Based Environmental Health Assessment Project, based on the PACE EH methodology was developed and focused in northern Doña Ana and southern Luna Counties.The goal was to conduct less than full assessments in order to generate action for community environmental health. The goal of these Community Environmental Health Assessments (CEHAs) was to improve the health status of New Mexico residents by:

Increasing community awareness around environmental health;

Increasing community, agency, and organization collaboration in addressing local environmental health issues by implementing the Protocol for Assessing Community Excellence in Environmental Heath (PACE EH) process; and

Developing an Environmental Health Action Plan that is based on community participation.

Two work groups formed to guide the CEHA process.They identified local issues through focus groups, photo documentaries, key informant interviews, and community surveys. Disease vector control, solid waste management, air quality, and occupational safety and health were identified as the most serious health concerns in northern Doña Ana County. In southern Luna County, water quality, indoor air quality, and food safety were identified as concerns.

Significant actions resulted from the assessments. There was an increased awareness about EH that led to the sponsorship of Worker Protection Standards pesticide safety training, for trainers and farm workers, an environmental camp for kids, children and environmental health training, and farm worker rights training. The assessments also generated support for community cleanup activities, the presentation of environmental health information to various coalitions and community groups, and participation in health fairs.By providing input and directions on southern New Mexico's environmental health needs, residents have become more aware of the relationship between health and the environment, and the willingness to address these issues will grow. The process also contributed to environmental health statewide because it linked up with a statewide Environmental Health Capacity Building project, thereby becoming a resource of information and expertise.

Through support from the Centers for Disease Control and Prevention (CDC), the New Mexico Department of Health's Environmental Health Epidemiology Bureau (EHEB) began a three-year process to build EH capacity in the state. After considerable collaboration, four broad goals were developed.One of the goals was to build capacity for community EH assessment. Another important goal was to build capacity for linking environmental exposure and health outcomes data. Efforts around this goal helped create the Environmental Public Health Tracking project, also supported by CDC.The tracking project also viewed CEHA has an important element in developing a tracking system. CDC strongly encouraged the use of PACE EH to assist with CEHA, and the efforts under way in the southern part of the state presented an excellent opportunity to extend the reach and effectiveness of PACE EH statewide.

How capacity was built

EHEB staff from both the capacity building and tracking projects worked with staff in SoAHEC to develop a Tool Box for Community Environmental Health Assessments for New Mexico.This 116-page bound book became an important resource for CEH training and assessments.The Tool Box is designed to raise environmental health awareness at the community level and to help governmental agencies increase their understanding of the community health assessment process.The ultimate goal of the CEHA Tool Box is to integrate the analysis of environmental conditions including the built environment with health. Specifically, it explains the PACE EH process and allows small communities to evaluate the connections between the environment and human health. Download the Tool Box here.

EHEB staff also developed a-one day training for CEHA which consisted of the following modules:

Overview of Environmental Health Indicators (what they are, how developed, and how used).

CEHA in Conclusion—Next Steps.

The CEHA training was intended to be integrated with the Public Health Division ongoing community health improvement process, promoting a common understanding of EH including greater understanding of the differences between a CEHA and other health assessments and knowledge about available resources for CEHAs. Approximately 150 people attended the trainings that were provided around the state on four different occasions. Participants included representatives from county and tribal health councils, New Mexico Environment Department central and district staff, Public Health Division central and district staff, and the Indian Health Service Environmental Health Services.

As a result of this working relationship with the Public Health Division, funds were made available to enable health councils to participate in a CEHA provided they attended the one-day training and conducted an assessment using the PACE EH process.PACE EH was adapted to local conditions and used to guide health council activities.

Specifically recommended tasks for the health councils included:

Define and characterize the community.

Assemble a community-based EH assessment team.

Generate a list of community-specific EH issues.

Develop locally appropriate indicators.

Create issue profiles.

Rank the issues.

The results

Community Environmental Health Assessments for prioritizing EH needs were conducted in 32 of 37 county and tribal health councils in 2004–2005.Councils held community meetings where environmental health needs, concerns, and strengths were discussed, and then EH needs were prioritized. Community health profiles were then modified to include these concerns.The top five EH issues were determined to be:

Drinking Water Quality/Quantity; Indoor Air Quality; SES/Poverty/Access to Healthcare.

Current and planned activities from thePACE EHprocesses

In 2006, Dona Ana County, which is home to the second largest city in New Mexico, Las Cruces, with support from NMDOH, brought together existing data and assessments and developed an EH action plan for the county.

Another action plan was developed by the Canoncito Band of Navajo in New Mexico.

Funds are being sought to assist other councils to develop and implement PACE EH guided community action plans in order to deal with the priority issues.

The Albuquerque Area Indian Health Services' Environment and Engineering Department worked with EHEB staff to encourage more assessments among tribes and has conducted PACE EH trainings.

Since the CEHAs, there has been more cooperation among communities, public health, and environmental agencies, which allows for an increase in sharing of resources, ideas, and efforts to improve environmental public health in New Mexico.

The EH priorities are serving as a guide for implementing the tracking system in New Mexico.